California State Polytechnic University, Humboldt

Primary specialty

Student Health Clinic/CenterTaxonomy code 261QS1000X

License

CLE 1688 Issued in CA

Legal business name

CALIFORNIA STATE POLYTECHNIC UNIVERSITY, HUMBOLDT

Practice address

1 Harpst St
Building 42
Arcata, CA 95521-8222

Phone

(707) 826-3146

Fax

(707) 826-5042

NPI assigned

May 10, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jennifer Lianne Sanford, PHD

Title

Executive Director, SHWS

Phone

(707) 826-3146

Specialties & licenses 1

Addresses

Other names 1

• Student Health Center Pharmacy Other name

Tax ID family

California State Polytechnic University Humboldt2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• California State Polytechnic University, Humboldt

  • Student Health Clinic/Center
  • Arcata, CA
  • NPI 1104991744
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jack Peter Guccione, MD

  • Student in an Organized Health Care Education/Training Program
  • Orange, CA
  • NPI 1336706266
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784073600000",
    "number": "1952515801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 HARPST ST BLDG 42",
            "city": "ARCATA",
            "state": "CA",
            "postal_code": "955218222",
            "telephone_number": "707-826-3146",
            "fax_number": "707-826-5042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 HARPST ST",
            "address_2": "BUILDING 42",
            "city": "ARCATA",
            "state": "CA",
            "postal_code": "955218222",
            "telephone_number": "707-826-3146",
            "fax_number": "707-826-5042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CALIFORNIA STATE POLYTECHNIC UNIVERSITY, HUMBOLDT",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-10",
        "last_updated": "2026-07-15",
        "certification_date": "2026-07-15",
        "status": "A",
        "authorized_official_last_name": "SANFORD",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "LIANNE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR, SHWS",
        "authorized_official_telephone_number": "707-826-3146",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "261QS1000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Student Health",
            "state": "CA",
            "license": "CLE 1688",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Student Health Center Pharmacy",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Viktoria Walda Byczkiewicz, PH.D.
• Emily Caffrey
• Shane Calhoun, PSY.D.
• California Em-I Medical Services, a Medical Corporation
• California State Polytechnic University, Humboldt
• Christopher Calva
• Candice Christine Campbell, LCSW
• Destinie Campos
• Courtney Amelia Campuzano
• Sarah Catherine Canale, LM, CPM

• Student Health Clinic/Center in Arcata, CA
• Providers in Arcata, CA by specialty
• Student Health Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.